EOCCO Benefits for members 64+

Soon, you will turn 65. This means you may qualify for Medicare and other coverage, as well as your EOCCO plan. You may also transfer from Medicaid to Medicare.

Read on to learn more about Medicare and to see what your EOCCO plan covers. You may also qualify for premium payment assistance programs. Contact us to find out. We’re here to answer your questions.

We are here to guide you and answer any questions you may have about your health plan so you can get the care your child needs.

What is Medicare?

Medicare is the federal health insurance program. You may qualify for Medicare if¹:

You are 65 or older
You are younger than 65 with certain disabilities
You have End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant, sometimes called ESRD)

¹Find out if you qualify for Medicare.

What will your health plan cover?

See what medical and dental services your plan will cover.

Benefit type	In-network coverage	What you need to know

Medical
Primary care provider (PCP)	Covered	All EOCCO members have been assigned an in-network PCP or clinic.
Yearly checkups	One visit per calendar year	It is important to schedule a checkup every year. Your doctor will provide a physical exam and talk about important topics. Topics include healthy eating, exercise, preventive shots, safe sex, how to manage stress and more.
Women's annual exam	Covered	This is an annual exam and family planning visit.
Immunizations (shots)	Covered	You do not need a referral. You can get these from your doctor or any network provider.
Emergency room	Covered	An emergency is a condition that puts your life in danger. Call 911 or go to the emergency room when you think you are in danger.
Urgent care	Covered	This is care that you need the same day. You may need this kind of care for serious pain, an injury or illness, or to avoid losing function in part of your body. You do not need an appointment.
Specialist	Covered	You will need a referral from your PCP before seeing a specialist.
Hospital	Covered	You will need prior authorization (pre-approval) for hospital stays. Your doctor will get this approval. You do not need pre-approval for emergencies.
Labs, tests, X-rays	Covered	These are covered if your doctor orders them. Other authorized specialists may also order them.

Vision
Exam	Limited coverage	EOCCO does not cover routine vision exams. Please call customer service for more information.
Glasses and contact lenses	Limited coverage	EOCCO does not cover glasses/contacts. Please call customer service for more information.

Hearing
Hearing test	Covered	If you are needing hearing services, your doctor will make a referral.
Hearing aids	Covered	If you are needing hearing services, your doctor will make a referral.

Behavioral health
Provider visit and mental health assessments	Covered	You can ask for help with depression, anxiety or other mental health services. Services are confidential. No referral is needed when visiting an in-network provider.
Wraparound services	Covered	Services that bring together a team of community members and others needed to support parents, families and children.

Dental
Preventive care	Covered	This includes exams, cleanings, fluoride, varnish and X-rays.
Restorative care	Covered	This includes treatment for cavities and other problems such as fillings, tooth removal, crowns and dentures.
Specialist care	Covered	You may need a referral to see a specialist. Please ask your dentist before you schedule a specialist appointment.
Orthodonia (braces)	Not covered	Braces are not covered unless you need them to treat cleft palate.
Urgent and immediate treatment	Covered	These are dental conditions that do not require emergency room care. Examples include toothache, swollen gums and lost fillings.
Emergency dental care	Covered	24 hours, 7 days a week. In a dental emergency, call your dentist day or night.

Pharmacy
Prescription medications	Covered	These are medications that a PCP, specialist or other provider prescribes. You can get your prescriptions at any in-network pharmacy. A list of these pharmacies is in the provider directory.
Get more pharmacy-related information

Screenings
Mammogram (breast X-ray)	Covered	Preventive care
Prostate screening	Covered	Preventive care
Colorectal screening	Covered	Preventive care
Drug and alcohol screening	Covered	Behavioral health
Depression screening and follow-up plan	Covered	Behavioral health

Coverage by age

View benefits and coverage for other age groups.

Benefits get better with age

Benefits get better with age

What is Medicare?

What will your health plan cover?

Coverage by age

Questions?

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